222 THE LARYNX, BRONCHI AND OESOPHAGUS embarrass the airway, especially in children, and this is prevented by intuba- tion; oesophagoscopy under local anaesthesia is uncomfortable for the patient, who, should he struggle, may precipitate damage to the wall of the oesophagus by the forceps, the oesophagoscope or the foreign body itself. Disc-shaped objects or those with smooth edges are easily withdrawn after a little experience. Sharp-edged objects require considerable dexterity to disimpact them from the walls of the oesophagus and to remove them without Fig, 112. Coin arrested in the lower part of the oesophagus. * further scratching. Large masses of unchewed meat tend to be friable and to come away in pieces, so that the procedure is prolonged. It may be tempting to push some of this through into the stomach, but the bolus may be held up by an undiagnosed carcinoma or hiatus hernia with oesophagitis, and such a manoeuvre may traumatize or perforate the oesophageal wall, and it is therefore to be condemned. Any scratch or tear of the oesophageal wall calls for a course of antibiotics and for feeding by sterile fluids for 24 hours. The danger of infection spreading through the oesophagus into the mediastinum must always be borne in mind if the wall has been damaged by a foreign body or by attempts at its removal. Rarely a sharp object may have perforated the wall of the oesophagus to lie partly within and partly outside the lumen. In this case removal is best made by an external incision and dissection to the oesophagus, when the tear may be sutured after the object has been removed.